Bulimia (bulimia nervosa) is a common eating disorder characterized by repeated cycles of binge eating followed by regurgitation or other forms of food purging. While the superficial source of this behavior is an obsession with body weight, shape or size, underlying motivations for bulimic actions include the desire to relieve anxiety or stress and the desire to assert some form of personal control in response to cultural, peer, or family pressure. The classic binge-and-purge cycle of bulimia can produce harmful effects on a number of different organs and systems; some of these effects are relatively minor, while others pose life-threatening health risks.
Bulimia Basics
Girls and women form the vast majority of bulimia sufferers. Unlike people with anorexia, who primarily control their weight by severely restricting their food intake, bulimics typically eat large amounts of food within a short span of time then seek to control their weight by purging this food from their bodies. In some cases, purging involves forced regurgitation of food before the body can full absorb its caloric content; in other cases, it involves the abuse of laxative products that move food rapidly through the intestines and trigger bowel emptying. Some bulimics supplement this binge-and-purge behavior with other weight-controlling techniques that include restricting their overall calorie intake, exercising heavily, and using diuretic substances that increase urine production. Depending on the specifics of his or her behavior, a person with the disorder can carry a normal amount of body weight, or appear noticeably under- or overweight.
Mouth-Related Effects
When bulimics regurgitate their food, they expose their mouths to the powerful acids that normally break down food inside the stomach. Over time, chronic exposure to these acids can lead to destruction of the outer covering of enamel that protects healthy teeth. Potential consequences of this enamel erosion include tooth staining and the development of tooth decay and cavities; in turn, the presence of dental cavities can lead to symptoms that include persistent or intermittent pain and unusual sensitivity to cold, hot, or sweet foods and beverages. Chronic exposure to stomach acid can also damage the mouth’s salivary glands and produce symptoms that include pain and swelling in the cheeks.
Other Gastrointestinal Effects
Your gastrointestinal tract is the pathway that allows you to take in food, process it for its nutrients, and eliminate its indigestible remains from your body. In addition to the entryway formed by your mouth and esophagus, portions of the tract include your stomach, small intestine, large intestine (colon), rectum and anus. In the esophagus, bulimia-related exposure to stomach acid can produce problems that include ulcers, abnormal narrowing associated with inflammation, and tears or ruptures. Stomach-related consequences of bulimia can also include ulcers and ruptures, as well as abnormal delays in normal stomach emptying. In the large intestine, repeated abuse of laxatives can partially alter or completely disrupt normal feces elimination. In severe cases of bulimia-related bowel disruption, surgery is needed to restore some degree of normal function. Other common gastrointestinal effects of the disorder include abdominal cramping, diarrhea and bloating.
Deadly Electrolyte Imbalances
In combination with diuretic abuse, laxative abuse in bulimics can trigger dangerous and potentially fatal imbalances in vital minerals called electrolytes. Normally, these minerals-which include electrically charged forms of calcium, sodium, potassium, chloride, phosphorus, and magnesium-help control essential body functions that include your relative blood acidity, or pH; your ability to properly control your muscles; and the relative fluid balance inside and outside your cells. When the balance between sodium and potassium is altered, changes in electrical signaling inside the heart can produce significant heartbeat irregularities; in turn, these irregularities can trigger the onset of fatal heart failure. In addition to electrolyte imbalances caused by diuretic and laxative abuse, bulimics are susceptible to potentially deadly electrolyte imbalances stemming from dehydration.
Bulimia and Pregnancy
Pregnant bulimics have increased risks for a range of different problems, including breathing difficulties, miscarriages, premature labor, the onset of a dangerous blood pressure-related condition called preeclampsia, the need for a cesarean section during childbirth, delivery of a stillborn child, and delivery of a child with abnormally low body weight. Women with the disorder also have increased risks for developing depression during pregnancy, as well as postpartum depression following pregnancy. In addition to preeclampsia, some pregnant bulimics develop high blood pressure as a consequence of excessive weight gain.
Other Potential Effects
The presence of chronic bulimia can lead to nutrient imbalances and the eventual onset of clinical malnutrition. In turn, malnutrition (or fluctuating body weight) can lead to reproductive changes in bulimic women that include irregular or completely absent menstruation. Chronic abuse of diuretics can alter or damage normal kidney function. Other potential health consequences of bulimia include abnormally low blood pressure, an abnormally low pulse, muscle fatigue, and abnormally dry skin.